How Meaningful Is Meaningful Use?

The government's Meaningful Use program mandating electronic health records is out of touch with reality. EHRs bog down process and can even worsen care.

Despite the existence of a government program called Meaningful Use, as a doctor I have yet to see a meaningful, positive impact on care from electronic health record (EHR) systems.

Regulators pushing for better and more cost effective medicine have decided that electronic technology, which has revolutionized many industries, is the solution needed to revolutionize medicine. We have been told that EHRs will make us better doctors, and they will make patients more responsible and engaged in their care. They go so far as to claim that EHRs will save doctors and hospitals time, that they will provide better coordination of care and save lives. While I can envision a world where this could be true, those of us living in the real world struggle with the disconnect between what is touted and what we experience every day.

It is true that some studies have shown specific benefits on selected measures when EHRs are used. Unfortunately, this is not true in all studies. Some studies have failed to show improvement of any kind when an EHR system is implemented. Some show an increase in adverse outcomes, including death. The EHR is not a proven technology. It is an experiment, and hospitals and clinics are beta testing new ways of doing things every day. The en masse adoption of EHRs into hospitals is akin to forcing car makers to make all vehicles from a new plastic that theoretically could make them safer without having shown that it really works.

High expectations for a new technology are typical, but pushing adoption of a technology that hasn't proven itself yet is inappropriate and flawed. Many haven't seen improvement in care coordination, efficiency, or patient engagement. In fact, some think things are worse with EHR. Patients now have to compete with computers to get their provider's full attention. Good documentation can take more time to input, and coordination of care still requires highly motivated teams. It is not clear if the EHR is more effective that a cohesive team with a spreadsheet. Additionally, health information exchanges are years away from truly interconnecting institutions and are not adding proven benefit to many.

Part of the problem is the menagerie of disconnected proprietary systems, all trying to solve problems in their own way. They don't speak to each other. Many are plagued with poor design and poor usability. These problems can be solved, but they should have been solved before we bought the software, not after.

In an effort to push EHR adoption and use, the Center for Medicare and Medicaid Services (CMS) has created the Meaningful Use (MU) incentive program, which defines what people should be doing with their EHR and pays them for doing it. The CMS has also instituted penalties for those who would remain on the sidelines. MU Stage 2 is ongoing, with the goals of increasing use of health information exchanges and patient engagement by enabling patients to access and transmit their own data. It also requires more intense use of EHR by physicians who must order tests, e-prescribe more consistently, look at labs in an electronic format, and keep everything safe from hackers.

On the surface, these seem laudable. Yet the technology remains cumbersome and disconnected, making many of these tasks difficult at best. Some tasks require someone else to act -- the patient or the health IT vendor. Even with a certified product, meeting MU Stage 2 requires overcoming some major hurdles. It is not clear that any of these things are improving care or saving time, money, and lives, as claimed by the CMS.

For example, in spite of compelling evidence to the contrary, computerized physician order entry (CPOE) is being pushed as the most efficient and safest way to order tests, order medications, and use standardized order sets. Certainly, when coupled with clinical decision support, there might be

David M. Denton is a board-certified pediatrician and member of the American Academy of Pediatrics. He is a partner of the Pocatello Children's Clinic in Pocatello, Idaho, and is affiliated with Portneuf Medical Center where he currently serves as the medical staff ... View Full Bio

I agree that we can learn a lot from the success and failures of others outside of the US. It does seem like we are trying to reinvent the wheel. It also seems that we are aiming a little to high with our expectations of what the technology can do at present. Perhaps using systems that would transmit documents back and forth with know protocols should have been rolled out before trying codify everything and make data discrete. There could be benefit to the approach we are trying, but we are trying to fly and we can't even walk yet.

EHR systems are in place in Europe for decades and simplified information exchange as well as insurance claims processing resulting in better care and substantial savings. So now finally the US gets it that doing everything with paper files might not be that great. But what happens? The wheel is reinvented in the US and it is square. Look across the pond and make use of the lessons learned in other countries...or is it to anti-american and socialist to look at the excellent health care systems in Europe?

In speaking to doctors for other stories for InformationWeek, I've found plenty of doctors who agree that EHRs are difficult to work with and introduce more work into an already busy schedule. That's one reason some practices switched their EHRs (as discussed in EHR Swaps Coming for Many Organizations). It's one reason some providers use scribes. And it's one reason some physicians cling to their paper files, despite financial incentives and pending penalties.

This is a pretty complete condemnation of electronic health records and government programs to promote their use. I hear plenty of other complaints about the specifics of the MU program, but it is it really as bad as Dr. Denton says?

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